Provider Demographics
NPI:1720032519
Name:ANTON, PEGGY LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LOUISE
Last Name:ANTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E CLAY ST
Mailing Address - Street 2:#34
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2076
Mailing Address - Country:US
Mailing Address - Phone:414-687-1565
Mailing Address - Fax:
Practice Address - Street 1:215 E CLAY ST
Practice Address - Street 2:#34
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2076
Practice Address - Country:US
Practice Address - Phone:414-687-1565
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56152-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38336200Medicaid